ANNEX I
Application form for authorisation to provide data reporting services as an APA or an ARM
Reference number: Date: From: Name of the applicant: Address: Legal Entity Identifier (where applicable): (Contact details of the designated contact person at the applicant) Full name: Telephone: Email: To: ESMA/National Competent Authority: Address: (Contact details of the designated contact point at ESMA/National Competent Authority) Address: Telephone: Email: Dear [insert appropriate name], In accordance with Article 2 of Commission Implementing Regulation (EU) 2025/1157 please find the authorisation application. CONTENT Please insert the information referred to under Commission Delegated Regulation (EU) 2025/1143. Please set out that information under the appropriate section or make reference to the relevant annexes containing the information. Information on the organisation (Article 2 of Delegated Regulation (EU) 2025/1143): Information on the ownership (Article 3 of Delegated Regulation (EU) 2025/1143): Information on corporate governance (Article 4 of Delegated Regulation (EU) 2025/1143): Information on the members of the management body (Article 5 of Delegated Regulation (EU) 2025/1143): Information on internal controls (Article 6 of Delegated Regulation (EU) 2025/1143): Information on digital operational resilience (Article 7 of Delegated Regulation (EU) 2025/1143): Information on conflicts of interest (Article 8 of Delegated Regulation (EU) 2025/1143): Information on organisational requirements regarding outsourcing (Article 9 of Delegated Regulation (EU) 2025/1143): Information on management of incomplete or potentially erroneous information by APAs (Article 10 of Delegated Regulation (EU) 2025/1143): Information on management of incomplete or potentially erroneous information by ARMs (Article 11 of Delegated Regulation (EU) 2025/1143): Information on connectivity of ARMs (Article 12 of Delegated Regulation (EU) 2025/1143): Information on machine readability (Article 13 of Delegated Regulation (EU) 2025/1143): Information on the details to be published by the APA (Article 14 of Delegated Regulation (EU) 2025/1143): Notes: Person at the applicant in charge of preparing the application: Full name: Status/position: Telephone: Email: Date: Signature: Nature of the application [tick the relevant box(es)]:
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